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Long-Term Morbidity and Mortality After a Clinically Diagnosed Vertebral Fracture in the Elderly—a 12- and 22-Year Follow-up of 257 Patients

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Abstract

The objective of this study was to analyze the long-term morbidity and mortality in patients with a clinically diagnosed vertebral fracture. Seventy men with a mean age of 70 years (range 50–91 years) and 187 women with a mean age of 72 years (range 50–96 years) were radiographically diagnosed as having a vertebral fracture in the thoracic or lumbar spine at the Malmö University Hospital (Sweden) during 1979. At the time of a follow-up examination 12 years later, 56 of the 76 patients who were still alive participated in an investigation that evaluated back pain and subjective health status by a questionnaire. Forty-four of these subjects also participated in a further radiologic examination of the spine. Serving as controls were age- and gender-matched subjects from the Malmö cohort of the European Vertebral Osteoporosis Study (EVOS). A mortality analysis was also conducted, covering 22 years following the baseline fracture. There were more female patients, who, in comparison with the controls, 12 years after the diagnosis, had had back pain during the year preceding the follow-up (72% vs 33%, P < 0.001), had current back pain (42% vs. 19%, P = 0.006), and had a subjectively impaired health status (44% vs. 17%, P < 0.001). The corresponding differences in men reached only a borderline significance, for both back pain during the year preceding the follow-up (60% vs. 28%, P = 0.07) and current back pain (40% vs. 15%, P = 0.09), whereas there was no difference in subjective health status. The incidence of new vertebral fractures in individuals with a clinically diagnosed vertebral fracture during the following 12 years was in men 25 per 1,000 person-years and in women 49 per 1000 person-years. There were more women with a new vertebral fracture at the 12-year follow-up examination who, in comparison with women without a new fracture, had had back pain during the year preceding the follow-up examination (90% vs. 50%, age-adjusted P = 0.02) and had current back pain (65% vs. 21%, age-adjusted P = 0.03). Women with a new vertebral fracture at the 12-year follow-up examination had a higher subsequent mortality rate in the next 10 years [age-adjusted hazard ratio 2.8 (95% CI 1.0–7.9)] as compared with women without. The mortality rate during the 22 years following the diagnosis among the male patients was 111.7 per 1,000 person-years as compared with 73.4 per 1,000 person-years among the male population at risk. The mortality rate among the female patients was 95.1 per 1,000 person-years as compared with 62.0 per 1,000 person-years among the female population at risk. We conclude that a clinically diagnosed thoracic or lumbar vertebral fracture in the elderly can be regarded as a risk factor for subsequent, long-term morbidity, especially in women, and for mortality in both genders.

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References

  1. EA Chrischilles CD Butler CS Davis RB Wallace (1991) ArticleTitleA model of lifetime osteoporosis impact Arch Intern Med 151 2026–2032 Occurrence Handle1:STN:280:DyaK38%2FivVWisQ%3D%3D Occurrence Handle10.1001/archinte.1991.00400100100017

    Article  CAS  Google Scholar 

  2. U Bengner O Johnell I Redlund-Johnell (1988) ArticleTitleChanges in incidence and prevalence of vertebral fractures during 30 years Calcif Tissue Int 42 293–296 Occurrence Handle1:STN:280:DyaL1c3ot1Wrtw%3D%3D Occurrence Handle10.1007/BF02556362

    Article  CAS  Google Scholar 

  3. JA Kanis O Johnell A Oden I Sembo I Redlund-Johnell A Dawson C Laet ParticleDe B Jonsson (2000) ArticleTitleLong-term risk of osteoporotic fracture in Malmö Osteoporos Int 11 669–674 Occurrence Handle1:STN:280:DC%2BD3M%2FlsFarsw%3D%3D Occurrence Handle10.1007/s001980070064

    Article  CAS  Google Scholar 

  4. C Cooper EJ Atkinson SJ Jacobsen WM O’Fallon LJ Melton Suffix3rd (1993) ArticleTitlePopulation-based study of survival after osteoporotic fractures Am J Epidemiol 137 1001–1005 Occurrence Handle1:STN:280:DyaK3szgsVeltw%3D%3D Occurrence Handle10.1093/oxfordjournals.aje.a116756

    Article  CAS  Google Scholar 

  5. JR Center TV Nguyen D Schneider PN Sambrook JA Eisman (1999) ArticleTitleMortality after all major types of osteoporotic fracture in men and women: an observational study Lancet 353 878–882 Occurrence Handle1:STN:280:DyaK1M7ptFOlug%3D%3D Occurrence Handle10.1016/S0140-6736(98)09075-8

    Article  CAS  Google Scholar 

  6. JA Cauley DE Thompson KC Ensrud JC Scott D Black (2000) ArticleTitleRisk of mortality following clinical fractures Osteoporos Int 11 556–561 Occurrence Handle1:STN:280:DC%2BD3crhtF2gsQ%3D%3D Occurrence Handle10.1007/s001980070075

    Article  CAS  Google Scholar 

  7. Zethraeus N BF, Johnell O, Kanis J, Önnby K, Jönsson B (2002) Costs and quality of life associated with osteoporosis related fractures—results from a Swedish survey. SSE/EFI Working Paper Series in Economics and Finance, at the Stockholm School of Economics, Working paper No. 512

  8. B Ettinger DM Black MC Nevitt AC Rundle JA Cauley SR Cummings HK Genant (1992) ArticleTitleContribution of vertebral deformities to chronic back pain and disability. The Study of Osteoporotic Fractures Research Group J Bone Miner Res 7 449–456 Occurrence Handle1:STN:280:DyaK38zgtlemsA%3D%3D Occurrence Handle10.1002/jbmr.5650070413

    Article  CAS  Google Scholar 

  9. G Leidig HW Minne P Sauer C Wuster J Wuster M Lojen F Raue R Ziegler (1990) ArticleTitleA study of complaints and their relation to vertebral destruction in patients with osteoporosis Bone Miner 8 217–229 Occurrence Handle1:STN:280:DyaK3c3ht12jtA%3D%3D Occurrence Handle10.1016/0169-6009(90)90107-Q

    Article  CAS  Google Scholar 

  10. KW Lyles DT Gold KM Shipp CF Pieper S Martinez PL Mulhausen (1993) ArticleTitleAssociation of osteoporotic vertebral compression fractures with impaired functional status Am J Med 94 595–601 Occurrence Handle1:STN:280:DyaK3s3ot1Cgtg%3D%3D Occurrence Handle10.1016/0002-9343(93)90210-G

    Article  CAS  Google Scholar 

  11. MC Nevitt B Ettinger DM Black K Stone SA Jamal K Ensrud M Segal HK Genant SR Cummings (1998) ArticleTitleThe association of radiographically detected vertebral fractures with back pain and function: a prospective study Ann Intern Med 128 793–800 Occurrence Handle1:STN:280:DyaK1c3ktlSjsQ%3D%3D Occurrence Handle10.7326/0003-4819-128-10-199805150-00001

    Article  CAS  Google Scholar 

  12. SL Silverman ME Minshall W Shen KD Harper S Xie (2001) ArticleTitleThe relationship of health-related quality of life to prevalent and incident vertebral fractures in postmenopausal women with osteoporosis: results from the Multiple Outcomes of Raloxifene Evaluation Study Arthritis Rheum 44 2611–2619 Occurrence Handle1:STN:280:DC%2BD3MnmsFeqsg%3D%3D Occurrence Handle10.1002/1529-0131(200111)44:11<2611::AID-ART441>3.0.CO;2-N

    Article  CAS  Google Scholar 

  13. C Cooper EJ Atkinson WM O’Fallon LJ Melton Suffix3rd (1992) ArticleTitleIncidence of clinically diagnosed vertebral fractures: a population-based study in Rochester, Minnesota, 1985–1989 J Bone Miner Res 7 221–227 Occurrence Handle1:STN:280:DyaK383jvVeksg%3D%3D Occurrence Handle10.1002/jbmr.5650070214

    Article  CAS  Google Scholar 

  14. DM Black NK Arden L Palermo J Pearson SR Cummings (1999) ArticleTitlePrevalent vertebral deformities predict hip fractures and new vertebral deformities but not wrist fractures. Study of Osteoporotic Fractures Research Group J Bone Miner Res 14 821–828 Occurrence Handle1:STN:280:DyaK1M3lsFyjtw%3D%3D Occurrence Handle10.1359/jbmr.1999.14.5.821

    Article  CAS  Google Scholar 

  15. PD Ross JW Davis RS Epstein RD Wasnich (1991) ArticleTitlePre-existing fractures and bone mass predict vertebral fracture incidence in women Ann Intern Med 114 919–923 Occurrence Handle1:STN:280:DyaK3M3itFCisQ%3D%3D Occurrence Handle10.7326/0003-4819-114-11-919

    Article  CAS  Google Scholar 

  16. R Lindsay SL Silverman C Cooper DA Hanley I Barton SB Broy A Licata L Benhamou P Geusens K Flowers H Stracke E Seeman (2001) ArticleTitleRisk of new vertebral fracture in the year following a fracture JAMA 285 320–323 Occurrence Handle1:STN:280:DC%2BD3M7kslamtw%3D%3D Occurrence Handle10.1001/jama.285.3.320

    Article  CAS  Google Scholar 

  17. M Gunnes D Mellstrom O Johnell (1998) ArticleTitleHow well can a previous fracture indicate a new fracture? A questionnaire study of 29,802 postmenopausal women Acta Orthop Scand 69 508–512 Occurrence Handle1:STN:280:DyaK1M%2FntVyktA%3D%3D Occurrence Handle10.3109/17453679808997788

    Article  CAS  Google Scholar 

  18. LJ Melton Suffix3rd EJ Atkinson C Cooper WM O’Fallon BL Riggs (1999) ArticleTitleVertebral fractures predict subsequent fractures Osteoporos Int 10 214–221 Occurrence Handle10.1007/s001980050218

    Article  Google Scholar 

  19. S Fujiwara F Kasagi M Yamada K Kodama (1997) ArticleTitleRisk factors for hip fracture in a Japanese cohort J Bone Miner Res 12 998–1004 Occurrence Handle1:STN:280:DyaK2szktlCnsw%3D%3D Occurrence Handle10.1359/jbmr.1997.12.7.998

    Article  CAS  Google Scholar 

  20. MA Kotowicz LJ Melton Suffix3rd C Cooper EJ Atkinson WM O’Fallon BL Riggs (1994) ArticleTitleRisk of hip fracture in women with vertebral fracture J Bone Miner Res 9 599–605 Occurrence Handle1:STN:280:DyaK2czjtVeqsA%3D%3D Occurrence Handle10.1002/jbmr.5650090503

    Article  CAS  Google Scholar 

  21. SR Cummings MC Nevitt WS Browner K Stone KM Fox KE Ensrud J Cauley D Black TM Vogt (1995) ArticleTitleRisk factors for hip fracture in white women. Study of Osteoporotic Fractures Research Group N Engl J Med 332 767–773 Occurrence Handle1:STN:280:DyaK2M7ms1aktw%3D%3D Occurrence Handle10.1056/NEJM199503233321202

    Article  CAS  Google Scholar 

  22. O Johnell A Oden F Caulin JA Kanis (2001) ArticleTitleAcute and long-term increase in fracture risk after hospitalization for vertebral fracture Osteoporos Int 12 207–214 Occurrence Handle1:STN:280:DC%2BD3M3oslKrsA%3D%3D Occurrence Handle10.1007/s001980170131

    Article  CAS  Google Scholar 

  23. E Orwoll M Ettinger S Weiss P Miller D Kendler J Graham S Adami K Weber R Lorenc P Pietschmann K Vandormael A Lombardi (2000) ArticleTitleAlendronate for the treatment of osteoporosis in men N Engl J Med 343 604–610 Occurrence Handle1:CAS:528:DC%2BD3cXmsFSqs7k%3D Occurrence Handle10.1056/NEJM200008313430902

    Article  CAS  Google Scholar 

  24. DM Black SR Cummings DB Karpf JA Cauley DE Thompson MC Nevitt DC Bauer HK Genant WL Haskell R Marcus SM Ott JC Torner S A Quandt TF Reiss KE Ensrud (1996) ArticleTitleRandomised trial of effect of alendronate on risk of fracture in women with existing vertebral fractures. Fracture Intervention Trial Research Group Lancet 348 1535–1541 Occurrence Handle1:CAS:528:DyaK2sXisFCktQ%3D%3D Occurrence Handle10.1016/S0140-6736(96)07088-2

    Article  CAS  Google Scholar 

  25. EG Lufkin HW Wahner WM O’Fallon SF Hodgson MA Kotowicz AW Lane HL Judd RH Caplan BL Riggs (1992) ArticleTitleTreatment of postmenopausal osteoporosis with transdermal estrogen Ann Intern Med 117 1–9 Occurrence Handle1:STN:280:DyaK383otFaltA%3D%3D Occurrence Handle10.7326/0003-4819-117-1-1

    Article  CAS  Google Scholar 

  26. B Ettinger DM Black BH Mitlak RK Knickerbocker T Nickelsen HK Genant C Christiansen PD Delmas JR Zanchetta J Stakkestad CC Gluer K Kraeger FJ Cohen S Eckert KE Ensrud LV Avioli P Lips SR Cummings (1999) ArticleTitleReduction of vertebral fracture risk in postmenopausal women with osteoporosis treated with raloxifene: results from a 3-year randomized clinical trial. Multiple Outcomes of Raloxifene Evaluation (MORE) Investigators JAMA 282 637–645 Occurrence Handle1:CAS:528:DyaK1MXlvVKqurg%3D Occurrence Handle10.1001/jama.282.7.637

    Article  CAS  Google Scholar 

  27. CH Chesnut Suffix3rd S Silverman K Andriano H Genant A Gimona S Harris D Kiel M LeBoff M Maricic P Miller C Moniz M Peacock P Richardson N Watts D Baylink (2000) ArticleTitleA randomized trial of nasal spray salmon calcitonin in postmenopausal women with established osteoporosis: the prevent recurrence of Osteoporotic fractures study. PROOF Study Group Am J Med 109 267–276 Occurrence Handle1:CAS:528:DC%2BD3cXms1Wku70%3D Occurrence Handle10.1016/S0002-9343(00)00490-3

    Article  CAS  Google Scholar 

  28. ST Harris NB Watts HK Genant CD McKeever T Hangartner M Keller CH Chesnut Suffix3rd J Brown EF Eriksen MS Hoseyni DW Axelrod PD Miller (1999) ArticleTitleEffects of risedronate treatment on vertebral and nonvertebral fractures in women with postmenopausal osteoporosis: a randomized controlled trial. Vertebral Efficacy with Risedronate Therapy (VERT) Study Group JAMA 282 1344–1352 Occurrence Handle1:CAS:528:DyaK1MXmvFansr0%3D Occurrence Handle10.1001/jama.282.14.1344

    Article  CAS  Google Scholar 

  29. J Reginster HW Minne OH Sorensen M Hooper C Roux ML Berandi B Lund D Ethgen S Pack I Roumagnac R Eastell (2000) ArticleTitleRandomized trial of the effects of risedronate on vertebral fractures in women with established postmenopausal osteoporosis. Vertebral Efficacy with Risedronate Therapy (VERT) Study Group Osteoporos Int 11 83–91 Occurrence Handle1:CAS:528:DC%2BD3cXhvFGgsr0%3D Occurrence Handle10.1007/s001980050010

    Article  CAS  Google Scholar 

  30. R Hasserius I Redlund-Johnell D Mellstrom C Johansson BE Nilsson O Johnell (2001) ArticleTitleVertebral deformation in urban Swedish men and women: prevalence based on 797 subjects Acta Orthop Scand 72 273–278 Occurrence Handle1:STN:280:DC%2BD3MvjtleqtA%3D%3D Occurrence Handle10.1080/00016470152846619

    Article  CAS  Google Scholar 

  31. TW O’Neill C Cooper JB Cannata JB Diaz Lopez K Hoszowski O Johnell RS Lorenc B Nilsson H Raspe O Stewart et al. (1994) ArticleTitleReproducibility of a questionnaire on risk factors for osteoporosis in a multicentre prevalence survey: the European Vertebral Osteoporosis Study Int J Epidemiol 23 559–565 Occurrence Handle10.1093/ije/23.3.559

    Article  Google Scholar 

  32. ICD-10. Classification of diseases and health problems 1997. Swedish version of ICD-10. Stockholm, Sweden: The National Swedish Board of Health and Welfare, 1997

  33. ICD-9. Classification of diseases 1987. Swedish version of ICD-9. Stockholm, Sweden: The National Swedish Board of Health and Welfare, 1987

  34. LJ Melton Suffix3rd AW Lane C Cooper R Eastell WM O’Fallon BL Riggs (1993) ArticleTitlePrevalence and incidence of vertebral deformities Osteoporos Int 3 113–119 Occurrence Handle10.1007/BF01623271

    Article  Google Scholar 

  35. K Weber M Lunt W Gowin T Lauermann G Armbrecht E Wieland G Leb T O’Neill D Felsenberg J Reeve (1999) ArticleTitleMeasurement imprecision in vertebral morphometry of spinal radiographs obtained in the European Prospective Osteoporosis Study: consequences for the identification of prevalent and incident deformities Br J Radiol 72 957–966 Occurrence Handle1:STN:280:DC%2BD3c7jvV2jsA%3D%3D Occurrence Handle10.1259/bjr.72.862.10673947

    Article  CAS  Google Scholar 

  36. AC Scane RM Francis AM Sutcliflte MJ Francis DJ Rawlings CL Chappie (1999) ArticleTitleCase-control study of the pathogenesis and sequelae of symptomatic vertebral fractures in men Osteoporos Int 9 91–97 Occurrence Handle1:STN:280:DyaK1M3psFWisg%3D%3D Occurrence Handle10.1007/s001980050120

    Article  CAS  Google Scholar 

  37. PD Ross B Ettinger JW Davis LJ Melton Suffix3rd RD Wasnich (1991) ArticleTitleEvaluation of adverse health outcomes associated with vertebral fractures Osteoporos Int 1 134–140 Occurrence Handle1:STN:280:DyaK387mtlKmsA%3D%3D Occurrence Handle10.1007/BF01625442

    Article  CAS  Google Scholar 

  38. C Huang PD Ross RD Wasnich (1996) ArticleTitleVertebral fracture and other predictors of physical impairment and health care utilization Arch Intern Med 156 2469–2475 Occurrence Handle1:STN:280:DyaK2s7gtVWksQ%3D%3D Occurrence Handle10.1001/archinte.1996.00440200087011

    Article  CAS  Google Scholar 

  39. C Matthis U Weber TW O’Neill H Raspe (1998) ArticleTitleHealth impact associated with vertebral deformities: results from the European Vertebral Osteoporosis Study (EVOS) Osteoporos Int 8 364–372 Occurrence Handle1:STN:280:DyaK1M7kvFSntA%3D%3D Occurrence Handle10.1007/s001980050076

    Article  CAS  Google Scholar 

  40. AA Ismail TW O’Neill C Cooper JD Finn AK Bhalla JB Cannata P Delmas JA Falch B Felsch K Hoszowski O Johnell JB Diaz-Lopez A Lopez Vaz F Marchand H Raspe DM Reid C Todd K Weber A Woolf J Reeve AJ Silman (1998) ArticleTitleMortality associated with vertebral deformity in men and women: results from the European Prospective Osteoporosis Study (EPOS) Osteoporos Int 8 291–297 Occurrence Handle1:STN:280:DyaK1M%2FhsVKnuw%3D%3D Occurrence Handle10.1007/s001980050067

    Article  CAS  Google Scholar 

  41. DM Kado WS Browner L Palermo MC Nevitt HK Genant SR Cummings (1999) ArticleTitleVertebral fractures and mortality in older women: a prospective study. Study of Osteoporotic Fractures Research Group Arch Intern Med 159 1215–1220 Occurrence Handle1:STN:280:DyaK1M3pslKguw%3D%3D Occurrence Handle10.1001/archinte.159.11.1215

    Article  CAS  Google Scholar 

  42. KE Ensrud DE Thompson JA Cauley MC Nevitt DM Kado MC Hochberg AC Santora Suffix2nd DM Black (2000) ArticleTitlePrevalent vertebral deformities predict mortality and hospitalization in older women with low bone mass. Fracture Intervention Trial Research Group J Am Geriatr Soc 48 241–249 Occurrence Handle1:STN:280:DC%2BD3c7psFWrtA%3D%3D Occurrence Handle10.1111/j.1532-5415.2000.tb02641.x

    Article  CAS  Google Scholar 

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  1. Departments of Orthopaedics and Departments of Diagnostic Radiology, Malmö University Hospital, Lund University, SE–205 02, Malmö, Sweden

    R. Hasserius, M.K. Karlsson, B. Jónsson, I. Redlund-Johnell & O. Johnell

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  1. R. Hasserius
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  2. M.K. Karlsson
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Hasserius, R., Karlsson, M., Jónsson, B. et al. Long-Term Morbidity and Mortality After a Clinically Diagnosed Vertebral Fracture in the Elderly—a 12- and 22-Year Follow-up of 257 Patients. Calcif Tissue Int 76, 235–242 (2005). https://doi.org/10.1007/s00223-004-2222-2

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